1205066891 NPI number — DR. VAMSHIDER REDDY KYATAM DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205066891 NPI number — DR. VAMSHIDER REDDY KYATAM DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KYATAM
Provider First Name:
VAMSHIDER
Provider Middle Name:
REDDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAMSHIDER REDDY
Provider Other First Name:
KYATAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205066891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26919 US HIGHWAY 380 E UNIT 216
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBREY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76227-7804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-213-3752
Provider Business Mailing Address Fax Number:
940-213-3763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26919 US HIGHWAY 380 E UNIT 216
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBREY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76227-7804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-813-4867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  24768 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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